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Borgquist R, Farouq M, Markstad H, Brandt J, Mörtsell D, Jensen S, Chaudhry U, Wang L. Diagnosis and treatment of the rare procedural complication of malpositioned pacing leads in the left heart: a single center experience. SCAND CARDIOVASC J 2022; 56:302-309. [PMID: 35880673 DOI: 10.1080/14017431.2022.2099013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives. This study assessed the management approach and outcome of the pacemaker or implantable cardioverter-defibrillator (ICD) leads malpositioned in the left heart. Malpositioned leads (MPLs) may have deleterious consequences, and appropriate management remains uncertain. Methods. The study population included all patients referred to a single institution for MPL in the left side of the heart after pacemaker or ICD implantation during the period from 2015 to 2021. The approach and outcome of lead management were retrospectively assessed. Results. During the study period, 6887 patients underwent device implantation. MPL was diagnosed in five patients (0.07%). In four cases, the pacing lead was placed in a coronary sinus (CS) branch, while the pacing lead was inside the left ventricle (LV) in one case. Symptoms suggestive of lead malposition were reported by 2 patients (40%). One of the patients presented with recurrent TIAs. Another presented with inappropriate ICD shocks. In one asymptomatic case, an ICD lead changed position from the right ventricle to the CS, suggesting idiopathic lead migration. In 4/5 patients, the leads were removed or repositioned by percutaneous approach, with no major periprocedural complications. Conclusions. In this series of MPL in the left heart, two patients presented with thromboembolic events or inappropriate ICD shocks. These serious complications highlight the critical need for early correct diagnosis and proper management of MPL.
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Affiliation(s)
- Rasmus Borgquist
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
| | - Maiwand Farouq
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
| | - Hanna Markstad
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
| | - Johan Brandt
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
| | - David Mörtsell
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
| | - Steen Jensen
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
| | - Uzma Chaudhry
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
| | - Lingwei Wang
- Cardiology, Department of clinical sciences Lund, Lund University, Arrhythmia section, Skane University Hospital, Malmö, Sweden
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Transvenous ICD lead malposition in the left ventricle: long-term follow-up. Clin Res Cardiol 2012; 102:159-61. [PMID: 22868694 DOI: 10.1007/s00392-012-0501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/24/2012] [Indexed: 10/28/2022]
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Sonnex E, Coulden R. Cardiac pacemaker lead placement: Do you need a lateral chest radiograph? Radiography (Lond) 2010. [DOI: 10.1016/j.radi.2010.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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